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Antibiotic — Oxazolidinone Pregnancy: Avoid — teratogenic in animal studies; use only if life-threatening and no alternative

Linezolid (Burns — Vancomycin-Resistant/Refractory MRSA)

Brand names: Zyvox

Adult dose

Dose: 600 mg IV or oral every 12 hours
Route: IV or Oral
Frequency: Every 12 hours
Max: 1200 mg/day
Active against MRSA, VRE, and glycopeptide-resistant organisms. 100% oral bioavailability — IV to oral switch possible without dose change. Restrict to VRE infection, vancomycin/teicoplanin failure, or where renal failure precludes glycopeptides. Maximum 28-day course.

Paediatric dose

Dose: 10 mg/kg
Route: IV / Oral
Frequency: Every 8–12 hours (age-dependent)
Max: 600 mg/dose
Children ≥12 years: 600 mg every 12 hours. Under 12 years: 10 mg/kg every 8 hours. Neonates: 10 mg/kg every 8–12 hours.

Dose adjustments

Renal

No dose adjustment required — not renally excreted. Monitor for metabolite accumulation in severe renal failure.

Hepatic

No specific adjustment for mild–moderate impairment. Caution in severe hepatic impairment.

Paediatric weight-based calculator

Children ≥12 years: 600 mg every 12 hours. Under 12 years: 10 mg/kg every 8 hours. Neonates: 10 mg/kg every 8–12 hours.

Clinical pearls

  • Myelosuppression: mandatory FBC weekly — thrombocytopenia most common; stop if platelets <100 × 10⁹/L
  • Serotonin syndrome risk is substantial — review ALL concurrent medications before prescribing. SSRIs must be stopped or linezolid used only with extreme caution and close monitoring.
  • Maximum 28-day course — peripheral and optic neuropathy risk increases beyond this. Report optic changes immediately.

Contraindications

  • Concurrent use with serotonergic agents (serotonin syndrome risk)
  • Uncontrolled hypertension
  • Phaeochromocytoma
  • MAOIs within 14 days

Side effects

  • Myelosuppression (thrombocytopenia, anaemia — especially >2 weeks)
  • Serotonin syndrome (with SSRIs, TCAs, opioids)
  • Peripheral neuropathy (prolonged)
  • Optic neuropathy (prolonged)
  • Lactic acidosis (mitochondrial toxicity)

Interactions

  • SSRIs/SNRIs (serotonin syndrome — contraindicated or extreme caution)
  • Tramadol/fentanyl (serotonin syndrome risk)
  • Pethidine (contraindicated)
  • Adrenergic agents (enhanced pressor response)
  • Tyramine-rich foods (MAOI-like effect — avoid aged cheese, cured meats, red wine)

Monitoring

  • FBC weekly (platelets, haemoglobin, WCC)
  • Signs of serotonin syndrome (agitation, fever, tremor, clonus)
  • Visual acuity if prolonged use
  • Lactate (lactic acidosis)

Reference: BNFc; BNF 90; MHRA Drug Safety Update (Linezolid); BBA Burns Infection Guidelines; BNFc. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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